Department of Trauma and Orthopaedics, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9, Canada.
Department of Trauma and Orthopaedics, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom.
Surgeon. 2020 Feb;18(1):53-61. doi: 10.1016/j.surge.2019.05.003. Epub 2019 Aug 10.
Allogeneic blood transfusion has been linked with an increase in the risk of surgical site infections (SSIs) through the mechanism of immunomodulation. However, no studies to date have investigated the direct relationship between blood conserving strategies including antifibrinolytics and wound complications after total hip arthroplasties (THA).
A systematic review and meta-analysis of published randomised controlled trials (RCTs) to investigate the effect of tranexamic acid (TXA) on wound complications after THAs has been conducted.
We identified 25 clinical trials which were suitable for detailed data extraction. There were no trials which utilised TXA in revision THA. All studies reported on wound complications including a total of 1608 patients. Using TXA led to a 2% reduction in the risk of developing wound complications compared to the control group with no significant statistical heterogeneity among the study groups (Risk Difference -0.02, 95%, confidence interval CI -0.04 to -0.00, P = 0.01, Heterogeneity I = 0%). However, there was no significant difference in clinical outcomes in terms of antibiotic treatment or surgical intervention among the study groups. TXA also reduced intraoperative, postoperative and total blood loss and led to a significant reduction in the proportion of patients requiring allogeneic blood transfusion with no significant differences in deep venous thrombosis, pulmonary embolisms, or other complications between the study groups.
TXA reduced blood loss and transfusion rates after primary THA surgery. It also reduced wound complication rates but the clinical significance of this needs further investigation through well designed and adequately powered RCTs.
异体输血通过免疫调节机制与手术部位感染（SSI）风险增加相关。然而，迄今为止尚无研究调查包括抗纤维蛋白溶解剂在内的血液保护策略与全髋关节置换术后（THA）伤口并发症之间的直接关系。
对已发表的随机对照试验（RCT）进行系统评价和荟萃分析，以调查氨甲环酸（TXA）对 THA 后伤口并发症的影响。
我们确定了 25 项适合详细数据提取的临床试验。没有试验在翻修 THA 中使用 TXA。所有研究均报告了伤口并发症，共有 1608 名患者。与对照组相比，使用 TXA 可使发生伤口并发症的风险降低 2%，但研究组之间无显著统计学异质性（风险差-0.02，95%置信区间 CI-0.04 至-0.00，P=0.01，异质性 I=0%）。然而，研究组之间在抗生素治疗或手术干预的临床结果方面没有显著差异。TXA 还减少了术中、术后和总失血量，并显著降低了需要异体输血的患者比例，研究组之间在深静脉血栓形成、肺栓塞或其他并发症方面没有显著差异。
TXA 减少了初次 THA 手术后的失血量和输血率。它还降低了伤口并发症的发生率，但这一临床意义需要通过精心设计和充分有力的 RCT 进一步研究。
